Gestión ineficaz de la salud: análisis de concepto

se trata de Análisis de Concepto en la perspectiva de Walker y Avant, operacionalizada por una revisión integrativa en las bases de datos Scopus, LILACS, PubMed, CINAHL, Web of Science, Science Direct e Cochrane, con los descriptores: Adherencia a la medicación; Cooperación y adherencia al tratamiento; y síndrome de inmunodeficiencia adquirida.

Resultados:

han sido identificados cinco atributos críticos para el concepto, a saber: recusa del paciente en seguir el plan terapéutico; el abandono del tratamiento y la agravación de señales y síntomas; la dificultad para alcanzar metas pactadas; la dificultad en seguir las orientaciones de los profesionales de salud; el proceso multifactorial y dinámico.

Conclusiones:

el concepto Gestión Ineficaz de la Salud se caracteriza por un proceso multifactorial y dinámico evidenciado por la recusa del paciente en seguir el plan terapéutico, favoreciendo el abandono del tratamiento y teniendo como consecuencias la agravación de señales y síntomas y no alcance de las metas.

Descriptores:
Diagnóstico de Enfermería; Cooperación y Adhesión al Tratamiento; Formación de Concepto; Adhesión a la Medicación; Síndrome de Inmunodeficiencia Adquirida

Studies	Year/Country/Database/Area	Type of Study / Level of Evidence (LE)	Concept attributes
E1(⁶6 Moriarty K, Genberg B, Norman B, Reece R. The effect of antiretroviral stock-outs on medication adherence among patients living with HIV in Ghana: a qualitative study. J Assoc Nurses AIDS Care. 2018;29(2):231-240. doi: 10.1016/j.jana.2017.09.014 https://doi.org/10.1016/j.jana.2017.09.0... )	2018/Ghana/Scopus/I	Descriptive LE = 6	Difficulty in reaching goals agreed between the person and the health professional
E2(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... )	2018/Ethiopia/Scopus/II	Longitudinal cohort LE = 3	Patient’s refusal to follow the therapeutic plan
E3(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... )	2017/Swaziland/Scopus/I	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E4(⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... )	2017/India/PubMed/ I	Cross sectional LE = 6	Patient’s refusal to follow the therapeutic plan
E5(¹⁰10 Conroy AA, McKenna SA, Leddy A. "If she is drunk, i don't want her to take it": partner beliefs and influence on use of alcohol and antiretroviral therapy in South African Couples. AIDS Behav. 2017;21(7):1885‐91. doi: 10.1007/s10461-017-1697-6 https://doi.org/10.1007/s10461-017-1697-... )	2017/South Africa /PubMed/II	Descriptive study LE = 6	Patient’s refusal to follow the therapeutic plan
E6(¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... )	2017/United Kingdom/Cochrane/I	Systematic review LE = 1	Abandonment of treatment leading to ineffective results and worsening of symptoms
E7(¹²12 Masa R, Chowa G, Nyirenda V. Chuma na Uchizi: a livelihood intervention to increase food security of people living with HIV in Rural Zambia. J Health Care Poor Underserved. 2018;29(1):349-72. doi: 10.1353/hpu.2018.0024 https://doi.org/10.1353/hpu.2018.0024... )	2017/Zambia/Scopus/III	Cross sectional LE = 6	Difficulty in reaching goals agreed between the person and the health professional
E8(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... )	2017/Uganda/Scopus/ II	Descriptive LE = 6	Patient’s refusal to follow the therapeutic plan
E9(¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... )	2016/Burkina Faso/Scopus/II	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E10(¹⁵15 Been SK, van de Vijver DA, Nieuwkerk PT. Risk factors for non-adherence to cART in immigrants with HIV living in the Netherlands: results from the ROtterdam ADherence (ROAD) Project. PLoS One. 2016;11(10):e0162800. doi: 10.1371/journal.pone.0162800 https://doi.org/10.1371/journal.pone.016... )	2016/Netherlands/PubMed/II	Cross sectional LE = 6	Difficulty in reaching goals agreed between the person and the health professional
E11(¹⁶16 Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV Medication adherence: examining distinct anxiety and depression symptoms among women living with HIV who experienced childhood sexual abuse. Behav Med. 2016;42(2):120-7. doi: 10.1080/08964289.2015.1045823 https://doi.org/10.1080/08964289.2015.10... )	2016/USA/PubMed/II	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E12(¹⁷17 Nguyen NT, Tran BX, Hwang LY, Markham CM, Swartz MD, Vidrine JI, et al. Motivation to quit smoking among HIV-positive smokers in Vietnam. BMC Pub Health. 2015;15:326. doi: 10.1186/s12889-015-1672-y https://doi.org/10.1186/s12889-015-1672-... )	2015/Vietnam/PubMed/III	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E13(¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... )	2015/USA/PubMed/II	RCT^* * RCT - Randomized Clinical Trial. LE = 2	Difficulty in reaching goals agreed between the person and the health professional
E14(¹⁹19 Coetzee B, Kagee A, Bland R. Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective. AIDS Care. 2015;27(3):315-21. doi: 10.1080/09540121.2014.967658 https://doi.org/10.1080/09540121.2014.96... )	2015/South Africa/PubMed/III	Descriptive LE = 6	Difficulty in reaching goals agreed between the person and the health professional
E15(²⁰20 Portelli MS, Tenni B, Kounnavong S, Chanthivilay P. Barriers to and facilitators of adherence to antiretroviral therapy among people living with HIV in Lao PDR: a qualitative study. Asia Pac J Public Health. 2015;27(2):NP778-NP788. doi: 10.1177/1010539512442082 https://doi.org/10.1177/1010539512442082... )	2015/Australia/PubMed/IV	Descriptive LE = 6	Difficulty in reaching goals agreed between the person and the health professional
E16(²¹21 Kalichman SC, Kalichman MO, Cherry C, Hoyt G, Washington C, Greble T, et al. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc. 18(1):19930. doi: 10.7448/IAS.18.1.19930 https://doi.org/10.7448/IAS.18.1.19930... )	2015/USA/Scopus/V	Cross sectional LE = 6	Patient’s refusal to follow the therapeutic plan
E17(²²22 Thielman NM, Ostermann J, Whetten K, Whetten R, Itemba D, Maro V, et al. Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer. J Acquir Immune Defic Syndr. 2014;65(3):e104-e109. doi: 10.1097/01.qai.0000437619.23031.83 https://doi.org/10.1097/01.qai.000043761... )	2014/Tanzania/Scopus/V	Cohort LE = 3	Abandonment of treatment leading to ineffective results and worsening of symptoms
E18(²³23 Batista JDL, Albuquerque MFPM, Santos ML, Miranda-Filho DB, Lacerda HR, Maruza M, et al Association between smoking, crack cocaine abuse and the discontinuation of combination antiretroviral therapy in Recife, Pernambuco, Brazil. Rev Inst Med Trop. 2014;56(2):127-32. doi: 10.1590/S0036-46652014000200007 https://doi.org/10.1590/S0036-4665201400... )	2014/Brazil/LILACS/II	Cross sectional LE = 6	Patient’s refusal to follow the therapeutic plan
E19(²⁴24 Betancur MN, Lins L, Oliveira IR, Brites C. Quality of life, anxiety and depression in patients with HIV/AIDS who present poor adherence to antiretroviral therapy: a cross-sectional study in Salvador, Brazil. Braz J Infect Dis. 2017;21(5):507-14. doi: 10.1016/j.bjid.2017.04.004 https://doi.org/10.1016/j.bjid.2017.04.0... )	2017/Brazil/Scopus/II	Cross sectional LE = 6	Patient’s refusal to follow the therapeutic plan
E20(²⁵25 Boni RB, Shepherd BE, Grinsztejn B, Cesar C, Cortés C, Padgett D, et al. Substance use and adherence among people living with HIV/AIDS Receiving cART in Latin America. AIDS Behav. 2016;20(11):2692-9. doi: 10.1007/s10461-016-1398-6 https://doi.org/10.1007/s10461-016-1398-... )	2016/Brazil/LILACS/IV	Cross sectional LE = 6	Patient’s refusal to follow the therapeutic plan
E21(²⁶26 Wohl DA, Kuwahara RK, Javadi K, Kirby C, Rosen DL, Napravnik S, et al. Financial barriers and lapses in treatment and care of HIV-infected adults in a Southern State in the United States. AIDS Patient Care STDS. 2017;31(11):463-9. doi: 10.1089/apc.2017.0125 https://doi.org/10.1089/apc.2017.0125... )	2017/USA/Web of Science/II	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E22(²⁷27 Lifson AR, Workneh S, Shenie T, Ayana DA, Melaku Z, Bezabih L, et al. Frequent use of khat, an amphetamine-like substance, as a risk factor for poor adherence and lost to follow-up among patients new to HIV Care in Ethiopia. AIDS Res Hum Retroviruses. 2017;33(10):995-8. doi: 10.1089/aid.2016.0274 https://doi.org/10.1089/aid.2016.0274... )	2017/Ethiopia/Web of Science/II	Cohort LE = 3	Patient’s refusal to follow the therapeutic plan
E23(²⁸28 Tocco JU. The Islamization of antiretroviral therapy: reconciling HIV treatment and religion in northern Nigeria. Soc Sci Med. 2017;190:75-82. doi: 10.1016/j.socscimed.2017.08.017 https://doi.org/10.1016/j.socscimed.2017... )	2017/Nigeria/Web of Science/II	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E24(²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... )	2018/USA/Web of Science/II	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E25(³⁰30 Bergmann JN, Wanyenze RK, Makumbi F, Naigino R, Kiene SM, Stockman JK. Maternal influences on access to and use of infant ARVs and HIV Health Services in Uganda. AIDS Behav. 2017;21(9):2693-702. doi: 10.1007/s10461-016-1528-1 https://doi.org/10.1007/s10461-016-1528-... )	2017/Uganda/Web of Science/IV	Cross sectional LE = 6	Difficulty following the guidelines of health professionals
E26(³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... )	2017/USA/Web of Science/IV	RCT ^* * RCT - Randomized Clinical Trial. LE = 2	Patient’s refusal to follow the therapeutic plan
E27(³²32 Tao J, Qian HZ, Kipp AM. Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS. 2017;31(3):401-6. doi: 10.1097/QAD.0000000000001287 https://doi.org/10.1097/QAD.000000000000... )	2017/China/Scopus/II	RCT ^* * RCT - Randomized Clinical Trial. LE = 2	Patient’s refusal to follow the therapeutic plan
E28(³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... )	2017/Australia/Cochrane/II	Systematic review LE = 1	Multifactorial and dynamic process that determines ineffective health control
E29(³⁴34 Sileo KM, Simbayi LC, Abrams A, Cloete A, Kiene SM. The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: event-level findings from a daily diary study. Drug Alcohol Depend. 2016;167:103-11. doi: 10.1016/j.drugalcdep.2016.07.028 https://doi.org/10.1016/j.drugalcdep.201... )	2016/South Africa/Scopus/II	Cohort LE = 3	Patient’s refusal to follow the therapeutic plan
E30(³⁵35 Hampanda KM. Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia. Soc Sci Med. 2016;153:123-130. doi: 10.1016/j.socscimed.2016.02.011 https://doi.org/10.1016/j.socscimed.2016... )	2016/Zambia/Scopus/II	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E31(³⁶36 Kosia A, Kakoko D, Semakafu AM, Nyamhanga T, Frumence G. Intimate partner violence and challenges facing women living with HIV/AIDS in accessing antiretroviral treatment at Singida Regional Hospital, central Tanzania. Glob Health Action. 2016;9:32307. doi: 10.3402/gha.v9.32307 https://doi.org/10.3402/gha.v9.32307... )	2016/Tanzania/Scopus/II	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E32(³⁷37 Dawson-Rose C, Gutin SA, Cummings B, Jaiantilal P, Johnson K, Mbofana F. ART adherence as a key component of prevention with persons living With HIV in Mozambique. J Assoc Nurses AIDS Care. 2016;27(1):44-56. doi: 10.1016/j.jana.2015.10.001 https://doi.org/10.1016/j.jana.2015.10.0... )	2016/Mozambique/Science Direct/I	Descriptive LE = 6	Difficulty following the guidelines of health professionals
E33(³⁸38 Obermeit LC, Morgan EE, Casaletto KB, Grant I, Woods SP, HIV Neurobehavioral Research Program Group. Antiretroviral non-adherence is associated with a retrieval profile of deficits in verbal episodic memory. Clin Neuropsychol. 2015;29(2):197-213. doi: 10.1080/13854046.2015.1018950 https://doi.org/10.1080/13854046.2015.10... )	2016/USA/Scopus/II	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E34(³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... )	2017/USA/Cochrane/II	Systematic review LE = 1	Abandonment of treatment leading to ineffective results and worsening of symptoms
E35(⁴⁰40 Kalichman SC, Grebler T, Amaral CM, McNerney M, White D, Kalichman MO, et al. Viral suppression and antiretroviral medication adherence among alcohol using HIV Positive Adults. Int J Behav Med[Internet]. 2014 [cited 2020 Jun 03];21(5):811-20. doi: 10.1007/s12529-013-9353-7 https://doi.org/10.1007/s12529-013-9353-... )	2014/USA/Science Direct/II	Cohort LE = 3	Patient’s refusal to follow the therapeutic plan
E36(⁴¹41 Shalihu N, Pretorius L, van Dyk A, Vander Stoep A, Hagopian A. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence. AIDS Care. 2014;26(8):968-75. doi: 10.1080/09540121.2014.880398 https://doi.org/10.1080/09540121.2014.88... )	2014/Namibia/Science Direct/I	Descriptive LE = 6	Patient’s refusal to follow the therapeutic plan
E37(⁴²42 Nagata D, Gutierrez EB. Características dos pacientes com HIV que faltaram a consultas agendadas. Rev Saúde Pública. 2015;49:95. doi: 10.1590/S0034-8910.2015049005145 https://doi.org/10.1590/S0034-8910.20150... )	2015/Brazil/Science Direct/IV	Cross sectional LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E38(⁴³43 Siefried KJ, Mao L, Cysique LA. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS. 2018;32(1):35-48. doi: 10.1097/QAD.0000000000001685 https://doi.org/10.1097/QAD.000000000000... )	2018/Australia/Science Direct/II	Cross sectional LE = 6	Difficulty following the guidelines of health professionals
E39(⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	2016/Australia/Cochrane/II	Systematic review LE = 1	Abandonment of treatment leading to ineffective results and worsening of symptoms
E40(⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... )	2014/Nigeria/ PubMed/I	Descriptive LE = 6	Difficulty following the guidelines of health professionals
E41(⁴⁶46 Katirayi L, Chadambuka A, Muchedzi A, Ahimbisibwe A, Musarandega R, Woelk G, et al. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women's perspectives. Reprod Health. 2017;14(1):124. doi: 10.1186/s12978-017-0387-1 https://doi.org/10.1186/s12978-017-0387-... )	2017/Malawi/Cinahl/I	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E42(⁴⁷47 Koto MV, Maharaj P. Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho. SAHARA J. 2016;13(1):53-59. doi: 10.1080/17290376.2016.1179588 https://doi.org/10.1080/17290376.2016.11... )	2016/Lesotho/PubMed/I	Descriptive LE = 6	Difficulty following the guidelines of health professionals
E43(⁴⁸48 Mûnene E, Ekman B. Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care centre in Kenya. AIDS Care. 2015;27(3):378-386. doi: 10.1080/09540121.2014.963020 https://doi.org/10.1080/09540121.2014.96... )	2015/Kenya/PubMed/III	Descriptive LE = 6	Abandonment of treatment leading to ineffective results and worsening of symptoms
E44(⁴⁹49 Whetten K, Shirey K, Pence BW. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One. 2013;8(10):e74771. doi: 10.1371/journal.pone.0074771 https://doi.org/10.1371/journal.pone.007... )	2013/Tanzania/Cinahl/II	Cohort LE = 3	Abandonment of treatment leading to ineffective results and worsening of symptoms
E45(⁵⁰50 Taylor BS, Reyes E, Levine EA. Patterns of geographic mobility predict barriers to engagement in HIV care and antiretroviral treatment adherence. AIDS Patient Care STDS. 2014;28(6):284-95. doi: 10.1089/apc.2014.0028 https://doi.org/10.1089/apc.2014.0028... )	2014/ Dominican Republic /Cinahl/II	Cohort LE = 3	Abandonment of treatment leading to ineffective results and worsening of symptoms
E46(⁵¹51 Motta MGC, Pedro ENR, Paula CC, Coelho DF, Ribeiro AC, Greff AP, et al. O silêncio no cotidiano do adolescente com HIV/AIDS. Rev Bras En-ferm. 2013;66(3):345-50. doi: 10.1590/S0034-71672013000300007 https://doi.org/10.1590/S0034-7167201300... )	2013/Brazil/LILACS/I	Descriptive LE = 6	Difficulty following the guidelines of health professionals

Background	Related factors (NANDA- I)
Alcohol use(⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... ,²¹21 Kalichman SC, Kalichman MO, Cherry C, Hoyt G, Washington C, Greble T, et al. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc. 18(1):19930. doi: 10.7448/IAS.18.1.19930 https://doi.org/10.7448/IAS.18.1.19930... ,²⁵25 Boni RB, Shepherd BE, Grinsztejn B, Cesar C, Cortés C, Padgett D, et al. Substance use and adherence among people living with HIV/AIDS Receiving cART in Latin America. AIDS Behav. 2016;20(11):2692-9. doi: 10.1007/s10461-016-1398-6 https://doi.org/10.1007/s10461-016-1398-... ,³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... ,³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... -³⁴34 Sileo KM, Simbayi LC, Abrams A, Cloete A, Kiene SM. The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: event-level findings from a daily diary study. Drug Alcohol Depend. 2016;167:103-11. doi: 10.1016/j.drugalcdep.2016.07.028 https://doi.org/10.1016/j.drugalcdep.201... ,⁴⁰40 Kalichman SC, Grebler T, Amaral CM, McNerney M, White D, Kalichman MO, et al. Viral suppression and antiretroviral medication adherence among alcohol using HIV Positive Adults. Int J Behav Med[Internet]. 2014 [cited 2020 Jun 03];21(5):811-20. doi: 10.1007/s12529-013-9353-7 https://doi.org/10.1007/s12529-013-9353-... )	NM
Side effects to medications(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... ,¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... ,¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... ,¹⁷17 Nguyen NT, Tran BX, Hwang LY, Markham CM, Swartz MD, Vidrine JI, et al. Motivation to quit smoking among HIV-positive smokers in Vietnam. BMC Pub Health. 2015;15:326. doi: 10.1186/s12889-015-1672-y https://doi.org/10.1186/s12889-015-1672-... -¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... ,²²22 Thielman NM, Ostermann J, Whetten K, Whetten R, Itemba D, Maro V, et al. Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer. J Acquir Immune Defic Syndr. 2014;65(3):e104-e109. doi: 10.1097/01.qai.0000437619.23031.83 https://doi.org/10.1097/01.qai.000043761... ,⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... )	NM
Depression(⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... ,¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... ,¹⁶16 Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV Medication adherence: examining distinct anxiety and depression symptoms among women living with HIV who experienced childhood sexual abuse. Behav Med. 2016;42(2):120-7. doi: 10.1080/08964289.2015.1045823 https://doi.org/10.1080/08964289.2015.10... ,²⁴24 Betancur MN, Lins L, Oliveira IR, Brites C. Quality of life, anxiety and depression in patients with HIV/AIDS who present poor adherence to antiretroviral therapy: a cross-sectional study in Salvador, Brazil. Braz J Infect Dis. 2017;21(5):507-14. doi: 10.1016/j.bjid.2017.04.004 https://doi.org/10.1016/j.bjid.2017.04.0... ,³²32 Tao J, Qian HZ, Kipp AM. Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS. 2017;31(3):401-6. doi: 10.1097/QAD.0000000000001287 https://doi.org/10.1097/QAD.000000000000... -³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... ,⁴⁹49 Whetten K, Shirey K, Pence BW. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One. 2013;8(10):e74771. doi: 10.1371/journal.pone.0074771 https://doi.org/10.1371/journal.pone.007... )	NM
Use of illicit drugs(¹⁷17 Nguyen NT, Tran BX, Hwang LY, Markham CM, Swartz MD, Vidrine JI, et al. Motivation to quit smoking among HIV-positive smokers in Vietnam. BMC Pub Health. 2015;15:326. doi: 10.1186/s12889-015-1672-y https://doi.org/10.1186/s12889-015-1672-... ,²¹21 Kalichman SC, Kalichman MO, Cherry C, Hoyt G, Washington C, Greble T, et al. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc. 18(1):19930. doi: 10.7448/IAS.18.1.19930 https://doi.org/10.7448/IAS.18.1.19930... ,²³23 Batista JDL, Albuquerque MFPM, Santos ML, Miranda-Filho DB, Lacerda HR, Maruza M, et al Association between smoking, crack cocaine abuse and the discontinuation of combination antiretroviral therapy in Recife, Pernambuco, Brazil. Rev Inst Med Trop. 2014;56(2):127-32. doi: 10.1590/S0036-46652014000200007 https://doi.org/10.1590/S0036-4665201400... ,²⁵25 Boni RB, Shepherd BE, Grinsztejn B, Cesar C, Cortés C, Padgett D, et al. Substance use and adherence among people living with HIV/AIDS Receiving cART in Latin America. AIDS Behav. 2016;20(11):2692-9. doi: 10.1007/s10461-016-1398-6 https://doi.org/10.1007/s10461-016-1398-... ,³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... ,³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... )	NM
Stigma(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... -⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... ,¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... ,²⁰20 Portelli MS, Tenni B, Kounnavong S, Chanthivilay P. Barriers to and facilitators of adherence to antiretroviral therapy among people living with HIV in Lao PDR: a qualitative study. Asia Pac J Public Health. 2015;27(2):NP778-NP788. doi: 10.1177/1010539512442082 https://doi.org/10.1177/1010539512442082... ,⁵⁰50 Taylor BS, Reyes E, Levine EA. Patterns of geographic mobility predict barriers to engagement in HIV care and antiretroviral treatment adherence. AIDS Patient Care STDS. 2014;28(6):284-95. doi: 10.1089/apc.2014.0028 https://doi.org/10.1089/apc.2014.0028... )	NM
Low education level(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... -¹⁵15 Been SK, van de Vijver DA, Nieuwkerk PT. Risk factors for non-adherence to cART in immigrants with HIV living in the Netherlands: results from the ROtterdam ADherence (ROAD) Project. PLoS One. 2016;11(10):e0162800. doi: 10.1371/journal.pone.0162800 https://doi.org/10.1371/journal.pone.016... ,³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... ,³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... )	NM
Anxiety(¹⁶16 Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV Medication adherence: examining distinct anxiety and depression symptoms among women living with HIV who experienced childhood sexual abuse. Behav Med. 2016;42(2):120-7. doi: 10.1080/08964289.2015.1045823 https://doi.org/10.1080/08964289.2015.10... -¹⁷17 Nguyen NT, Tran BX, Hwang LY, Markham CM, Swartz MD, Vidrine JI, et al. Motivation to quit smoking among HIV-positive smokers in Vietnam. BMC Pub Health. 2015;15:326. doi: 10.1186/s12889-015-1672-y https://doi.org/10.1186/s12889-015-1672-... ,²⁴24 Betancur MN, Lins L, Oliveira IR, Brites C. Quality of life, anxiety and depression in patients with HIV/AIDS who present poor adherence to antiretroviral therapy: a cross-sectional study in Salvador, Brazil. Braz J Infect Dis. 2017;21(5):507-14. doi: 10.1016/j.bjid.2017.04.004 https://doi.org/10.1016/j.bjid.2017.04.0... ,³²32 Tao J, Qian HZ, Kipp AM. Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS. 2017;31(3):401-6. doi: 10.1097/QAD.0000000000001287 https://doi.org/10.1097/QAD.000000000000... -³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... )	NM
Financial difficulties(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,²⁰20 Portelli MS, Tenni B, Kounnavong S, Chanthivilay P. Barriers to and facilitators of adherence to antiretroviral therapy among people living with HIV in Lao PDR: a qualitative study. Asia Pac J Public Health. 2015;27(2):NP778-NP788. doi: 10.1177/1010539512442082 https://doi.org/10.1177/1010539512442082... ,²⁶26 Wohl DA, Kuwahara RK, Javadi K, Kirby C, Rosen DL, Napravnik S, et al. Financial barriers and lapses in treatment and care of HIV-infected adults in a Southern State in the United States. AIDS Patient Care STDS. 2017;31(11):463-9. doi: 10.1089/apc.2017.0125 https://doi.org/10.1089/apc.2017.0125... ,³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... ,⁴³43 Siefried KJ, Mao L, Cysique LA. Concomitant medication polypharmacy, interactions and imperfect adherence are common in Australian adults on suppressive antiretroviral therapy. AIDS. 2018;32(1):35-48. doi: 10.1097/QAD.0000000000001685 https://doi.org/10.1097/QAD.000000000000... )	Perceived barrier
Difficulty of adequate access to care(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... -⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,¹²12 Masa R, Chowa G, Nyirenda V. Chuma na Uchizi: a livelihood intervention to increase food security of people living with HIV in Rural Zambia. J Health Care Poor Underserved. 2018;29(1):349-72. doi: 10.1353/hpu.2018.0024 https://doi.org/10.1353/hpu.2018.0024... ,²⁰20 Portelli MS, Tenni B, Kounnavong S, Chanthivilay P. Barriers to and facilitators of adherence to antiretroviral therapy among people living with HIV in Lao PDR: a qualitative study. Asia Pac J Public Health. 2015;27(2):NP778-NP788. doi: 10.1177/1010539512442082 https://doi.org/10.1177/1010539512442082... ,³³33 Gesesew HA, Ward P, Hajito KW, Feyissa GT, Mohammadi L, Mwanri L. Discontinuation from antiretroviral therapy: a continuing challenge among adults in HIV Care in Ethiopia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169651. doi: 10.1371/journal.pone.0169651 https://doi.org/10.1371/journal.pone.016... )	Perceived barrier
Lack of social support(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... ,¹⁵15 Been SK, van de Vijver DA, Nieuwkerk PT. Risk factors for non-adherence to cART in immigrants with HIV living in the Netherlands: results from the ROtterdam ADherence (ROAD) Project. PLoS One. 2016;11(10):e0162800. doi: 10.1371/journal.pone.0162800 https://doi.org/10.1371/journal.pone.016... -¹⁶16 Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV Medication adherence: examining distinct anxiety and depression symptoms among women living with HIV who experienced childhood sexual abuse. Behav Med. 2016;42(2):120-7. doi: 10.1080/08964289.2015.1045823 https://doi.org/10.1080/08964289.2015.10... ,⁴¹41 Shalihu N, Pretorius L, van Dyk A, Vander Stoep A, Hagopian A. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence. AIDS Care. 2014;26(8):968-75. doi: 10.1080/09540121.2014.880398 https://doi.org/10.1080/09540121.2014.88... ,⁴⁹49 Whetten K, Shirey K, Pence BW. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One. 2013;8(10):e74771. doi: 10.1371/journal.pone.0074771 https://doi.org/10.1371/journal.pone.007... )	Insufficient social support
Forgetfulness(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... ,⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... ,¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... ,¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... )	NM
Fear of revealing the disease(⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... ,⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... ,²⁸28 Tocco JU. The Islamization of antiretroviral therapy: reconciling HIV treatment and religion in northern Nigeria. Soc Sci Med. 2017;190:75-82. doi: 10.1016/j.socscimed.2017.08.017 https://doi.org/10.1016/j.socscimed.2017... )	NM
Many medicines to take(¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... -¹⁹19 Coetzee B, Kagee A, Bland R. Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective. AIDS Care. 2015;27(3):315-21. doi: 10.1080/09540121.2014.967658 https://doi.org/10.1080/09540121.2014.96... ,⁵¹51 Motta MGC, Pedro ENR, Paula CC, Coelho DF, Ribeiro AC, Greff AP, et al. O silêncio no cotidiano do adolescente com HIV/AIDS. Rev Bras En-ferm. 2013;66(3):345-50. doi: 10.1590/S0034-71672013000300007 https://doi.org/10.1590/S0034-7167201300... )	Difficulty controlling a complex treatment regimen
Beliefs of mixing alcohol and medication(⁹9 Schensul SL, Ha T, Schensul JJ, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716-24. doi: 10.15288/jsad.2017.78.716 https://doi.org/10.15288/jsad.2017.78.71... -¹⁰10 Conroy AA, McKenna SA, Leddy A. "If she is drunk, i don't want her to take it": partner beliefs and influence on use of alcohol and antiretroviral therapy in South African Couples. AIDS Behav. 2017;21(7):1885‐91. doi: 10.1007/s10461-017-1697-6 https://doi.org/10.1007/s10461-017-1697-... ,²¹21 Kalichman SC, Kalichman MO, Cherry C, Hoyt G, Washington C, Greble T, et al. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc. 18(1):19930. doi: 10.7448/IAS.18.1.19930 https://doi.org/10.7448/IAS.18.1.19930... )	NM
Being away from home or traveling(¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... ,¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... ,⁵⁰50 Taylor BS, Reyes E, Levine EA. Patterns of geographic mobility predict barriers to engagement in HIV care and antiretroviral treatment adherence. AIDS Patient Care STDS. 2014;28(6):284-95. doi: 10.1089/apc.2014.0028 https://doi.org/10.1089/apc.2014.0028... )	NM
Religious beliefs incompatible with the therapeutic plan(²²22 Thielman NM, Ostermann J, Whetten K, Whetten R, Itemba D, Maro V, et al. Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer. J Acquir Immune Defic Syndr. 2014;65(3):e104-e109. doi: 10.1097/01.qai.0000437619.23031.83 https://doi.org/10.1097/01.qai.000043761... ,²⁸28 Tocco JU. The Islamization of antiretroviral therapy: reconciling HIV treatment and religion in northern Nigeria. Soc Sci Med. 2017;190:75-82. doi: 10.1016/j.socscimed.2017.08.017 https://doi.org/10.1016/j.socscimed.2017... ,⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... )	NM
Lack of support from partner and family(³⁰30 Bergmann JN, Wanyenze RK, Makumbi F, Naigino R, Kiene SM, Stockman JK. Maternal influences on access to and use of infant ARVs and HIV Health Services in Uganda. AIDS Behav. 2017;21(9):2693-702. doi: 10.1007/s10461-016-1528-1 https://doi.org/10.1007/s10461-016-1528-... ,⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... -⁴⁶46 Katirayi L, Chadambuka A, Muchedzi A, Ahimbisibwe A, Musarandega R, Woelk G, et al. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women's perspectives. Reprod Health. 2017;14(1):124. doi: 10.1186/s12978-017-0387-1 https://doi.org/10.1186/s12978-017-0387-... )	Insufficient social support
Unpleasant taste of medicines(⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... ,⁵¹51 Motta MGC, Pedro ENR, Paula CC, Coelho DF, Ribeiro AC, Greff AP, et al. O silêncio no cotidiano do adolescente com HIV/AIDS. Rev Bras En-ferm. 2013;66(3):345-50. doi: 10.1590/S0034-71672013000300007 https://doi.org/10.1590/S0034-7167201300... )	NM
Lack of medication at home(⁶6 Moriarty K, Genberg B, Norman B, Reece R. The effect of antiretroviral stock-outs on medication adherence among patients living with HIV in Ghana: a qualitative study. J Assoc Nurses AIDS Care. 2018;29(2):231-240. doi: 10.1016/j.jana.2017.09.014 https://doi.org/10.1016/j.jana.2017.09.0... -⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... )	NM
Denial of the disease(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,¹⁹19 Coetzee B, Kagee A, Bland R. Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective. AIDS Care. 2015;27(3):315-21. doi: 10.1080/09540121.2014.967658 https://doi.org/10.1080/09540121.2014.96... )	NM
Violence from partners and family members(³⁵35 Hampanda KM. Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia. Soc Sci Med. 2016;153:123-130. doi: 10.1016/j.socscimed.2016.02.011 https://doi.org/10.1016/j.socscimed.2016... -³⁶36 Kosia A, Kakoko D, Semakafu AM, Nyamhanga T, Frumence G. Intimate partner violence and challenges facing women living with HIV/AIDS in accessing antiretroviral treatment at Singida Regional Hospital, central Tanzania. Glob Health Action. 2016;9:32307. doi: 10.3402/gha.v9.32307 https://doi.org/10.3402/gha.v9.32307... )	Family conflict
Dissatisfaction with care(¹⁰10 Conroy AA, McKenna SA, Leddy A. "If she is drunk, i don't want her to take it": partner beliefs and influence on use of alcohol and antiretroviral therapy in South African Couples. AIDS Behav. 2017;21(7):1885‐91. doi: 10.1007/s10461-017-1697-6 https://doi.org/10.1007/s10461-017-1697-... -¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... )	NM
Secret use of treatment(¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... )	NM
Lack of hope for the future(⁴⁵45 Okuboyejo S. Non-adherence to medication in outpatient setting in Nigeria: the effect of employment status. Glob J Health Sci. 2014;6(3):37-44. doi: 10.5539/gjhs.v6n3p37 https://doi.org/10.5539/gjhs.v6n3p37... )	NM
Age below 40 years(²³23 Batista JDL, Albuquerque MFPM, Santos ML, Miranda-Filho DB, Lacerda HR, Maruza M, et al Association between smoking, crack cocaine abuse and the discontinuation of combination antiretroviral therapy in Recife, Pernambuco, Brazil. Rev Inst Med Trop. 2014;56(2):127-32. doi: 10.1590/S0036-46652014000200007 https://doi.org/10.1590/S0036-4665201400... )	NM
Blame(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... )	NM
Change in routine that makes it difficult to implement the regime(¹⁸18 Saberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE. Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants. AIDS Patient Care STDS. 2015;29(3):111-6. doi: 10.1089/apc.2014.0255 https://doi.org/10.1089/apc.2014.0255... )	Difficulty moving through complex care systems
Barriers between customer and provider(¹⁹19 Coetzee B, Kagee A, Bland R. Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective. AIDS Care. 2015;27(3):315-21. doi: 10.1080/09540121.2014.967658 https://doi.org/10.1080/09540121.2014.96... )	Perceived barrier
Difficulty understanding the health team’s guidelines(³⁰30 Bergmann JN, Wanyenze RK, Makumbi F, Naigino R, Kiene SM, Stockman JK. Maternal influences on access to and use of infant ARVs and HIV Health Services in Uganda. AIDS Behav. 2017;21(9):2693-702. doi: 10.1007/s10461-016-1528-1 https://doi.org/10.1007/s10461-016-1528-... )	Insufficient knowledge about the therapeutic regimen
Lack of expectations for clinical improvement(¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... )	Feeling of helplessness
Lack of scheduled appointments(⁴²42 Nagata D, Gutierrez EB. Características dos pacientes com HIV que faltaram a consultas agendadas. Rev Saúde Pública. 2015;49:95. doi: 10.1590/S0034-8910.2015049005145 https://doi.org/10.1590/S0034-8910.20150... )	NM
Negative health beliefs incompatible with the plan(⁴⁶46 Katirayi L, Chadambuka A, Muchedzi A, Ahimbisibwe A, Musarandega R, Woelk G, et al. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women's perspectives. Reprod Health. 2017;14(1):124. doi: 10.1186/s12978-017-0387-1 https://doi.org/10.1186/s12978-017-0387-... )	Decision conflict
Discrimination(¹¹11 Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa. AIDS. 2017;31(7):995-1007. doi: 10.1097/QAD.0000000000001416 https://doi.org/10.1097/QAD.000000000000... )	NM
Less patient involvement in treatment due to the service’s low credibility(⁴⁸48 Mûnene E, Ekman B. Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care centre in Kenya. AIDS Care. 2015;27(3):378-386. doi: 10.1080/09540121.2014.963020 https://doi.org/10.1080/09540121.2014.96... )	NM

Consequences	Defining characteristics (NANDA-I)
Inefficient decisions to achieve treatment goals(²¹21 Kalichman SC, Kalichman MO, Cherry C, Hoyt G, Washington C, Greble T, et al. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc. 18(1):19930. doi: 10.7448/IAS.18.1.19930 https://doi.org/10.7448/IAS.18.1.19930... ,²⁵25 Boni RB, Shepherd BE, Grinsztejn B, Cesar C, Cortés C, Padgett D, et al. Substance use and adherence among people living with HIV/AIDS Receiving cART in Latin America. AIDS Behav. 2016;20(11):2692-9. doi: 10.1007/s10461-016-1398-6 https://doi.org/10.1007/s10461-016-1398-... ,³¹31 Cioe PA, Gamarel KE, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Cigarette smoking and Antiretroviral Therapy (ART) Adherence in a sample of heavy drinking HIV-Infected men who have sex with men (MSM). AIDS Behav. 2017;21(7):1956-63. doi: 10.1007/s10461-016-1496-5 https://doi.org/10.1007/s10461-016-1496-... ,³⁴34 Sileo KM, Simbayi LC, Abrams A, Cloete A, Kiene SM. The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: event-level findings from a daily diary study. Drug Alcohol Depend. 2016;167:103-11. doi: 10.1016/j.drugalcdep.2016.07.028 https://doi.org/10.1016/j.drugalcdep.201... )	Ineffective choices in daily life to achieve health goals
Complications associated with the development of the disease(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Neurological and cognitive disorders(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Cardiovascular disorders(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Coloproctological manifestations(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Periodontal changes(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Ocular manifestations(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Renal disorders(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Neoplasms(¹³13 Buregyeya E, Naigino R, Mukose A. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17(1):94. doi: 10.1186/s12884-017-1276-x https://doi.org/10.1186/s12884-017-1276-... ,²⁹29 M Elicer I, Byrd D, Clark US, Morgello S, Robinson-Papp J. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514-22. doi: 10.1007/s13365-018-0640-6 https://doi.org/10.1007/s13365-018-0640-... ,³⁹39 Nadel J, Holloway CJ. Screening and risk assessment for coronary artery disease in HIV infection: an unmet need. HIV Med. 2017;18(4):292-9. doi: 10.1111/hiv.12422 https://doi.org/10.1111/hiv.12422... ,⁴⁴44 Saylor D, Dickens AM, Sacktor N. HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol. 2016;12(4):234-48. doi: 10.1038/nrneurol.2016.27 https://doi.org/10.1038/nrneurol.2016.27... )	NM
Opportunistic infections(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... )	NM
Tuberculosis / HIV co-infection(⁸8 Ahmed CV, Jolly P, Padilla L, Malinga M, Harris C, Mthethwa N, et al. Barriers to ART initiation for HIV-positive children 2-18 months in Swaziland. Afr J AIDS Res. 2018;17(2):193-202. doi: 10.2989/16085906.2018.1488266 https://doi.org/10.2989/16085906.2018.14... ,¹⁴14 Guira O, Kaboré DSR, Dao G, Zagré N, Zohoncon TM, Pietra V, et al. Prévalence de la non-observance à la trithérapie antirétrovirale et facteurs cliniques et thérapeutiques associés chez les patients à Ouagadougou (Burkina Faso). Méd Santé Tropic. 2016;26(4):396-401. doi: 10.1684/mst.2016.0604 https://doi.org/10.1684/mst.2016.0604... )	NM
Failure in the practice of reducing risk factors(⁶6 Moriarty K, Genberg B, Norman B, Reece R. The effect of antiretroviral stock-outs on medication adherence among patients living with HIV in Ghana: a qualitative study. J Assoc Nurses AIDS Care. 2018;29(2):231-240. doi: 10.1016/j.jana.2017.09.014 https://doi.org/10.1016/j.jana.2017.09.0... -⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... )	Failure to act to reduce risk factors
Failure to incorporate treatment into daily life(⁶6 Moriarty K, Genberg B, Norman B, Reece R. The effect of antiretroviral stock-outs on medication adherence among patients living with HIV in Ghana: a qualitative study. J Assoc Nurses AIDS Care. 2018;29(2):231-240. doi: 10.1016/j.jana.2017.09.014 https://doi.org/10.1016/j.jana.2017.09.0... -⁷7 Tegegne AS, Ndlovu P, Zewotir T. Determinants of CD4 cell count change and time-to default from HAART;a comparison of separate and joint models. BMC Infect Dis. 2018;18(1):197. doi: 10.1186/s12879-018-3108-7 https://doi.org/10.1186/s12879-018-3108-... )	Failure to include the treatment regimen in daily life
Development of minor mental disorders(²⁷27 Lifson AR, Workneh S, Shenie T, Ayana DA, Melaku Z, Bezabih L, et al. Frequent use of khat, an amphetamine-like substance, as a risk factor for poor adherence and lost to follow-up among patients new to HIV Care in Ethiopia. AIDS Res Hum Retroviruses. 2017;33(10):995-8. doi: 10.1089/aid.2016.0274 https://doi.org/10.1089/aid.2016.0274... )	NM
Memory deficits(³⁸38 Obermeit LC, Morgan EE, Casaletto KB, Grant I, Woods SP, HIV Neurobehavioral Research Program Group. Antiretroviral non-adherence is associated with a retrieval profile of deficits in verbal episodic memory. Clin Neuropsychol. 2015;29(2):197-213. doi: 10.1080/13854046.2015.1018950 https://doi.org/10.1080/13854046.2015.10... )	NM
Conduct of ineffective health control(⁴¹41 Shalihu N, Pretorius L, van Dyk A, Vander Stoep A, Hagopian A. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence. AIDS Care. 2014;26(8):968-75. doi: 10.1080/09540121.2014.880398 https://doi.org/10.1080/09540121.2014.88... )	NM
Difficulty understanding the therapeutic plan(⁴¹41 Shalihu N, Pretorius L, van Dyk A, Vander Stoep A, Hagopian A. Namibian prisoners describe barriers to HIV antiretroviral therapy adherence. AIDS Care. 2014;26(8):968-75. doi: 10.1080/09540121.2014.880398 https://doi.org/10.1080/09540121.2014.88... )	Difficulty with the prescribed regimen

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[1] Corresponding author: Wenysson Noleto dos Santos E-mail: wenysson-noleto@hotmail.com